The religious leaders' letter to the nation follows in full:

To the Voters of New Zealand

At the upcoming General Election, you will be asked to vote in a binding referendum on the End of Life Choice Act 2019. We, the undersigned religious leaders, wish to share with you our grave concerns about the final form of this Act.

We speak out of our extensive experience of caring for the dying. We know the effectiveness of compassionate end of life palliative care – care that is able to address not just the physical suffering of people who are dying, but also their emotional, spiritual and psychological suffering, as well as that of whānau and friends.

Medical practices that are part of good end-of-life care – ceasing treatment, Do Not Resuscitate Orders, Advanced Care Directives and turning off life support – are already legal and part of our health care choices and are not part of this proposed law.

The referendum question is not about the desirability of some form of ‘assisted dying’. Rather, we are being asked to vote on a specific piece of legislation – the End of Life Choice Act. The key consideration for all of us is the robustness and safety of this Act. Our concerns are about the lack of safeguards in the Act and the dangers it would present.

We note that the Act differs in the quality of its processes and safeguards from other laws overseas:

• The Act is not just designed for a small number of hard cases. It is broader than laws in Victoria and the United States because it allows both assisted suicide and euthanasia.
• This is not an Act of ‘last resort’ – there is no requirement to try effective treatments or palliative care. There is also no corresponding right in the proposed law for people to access palliative care.
• People will be able to access an assisted death without being in any physical pain. Overseas research shows people choose assisted death primarily out of a fear of being a burden and/or being disabled. 
• The Act does not require a patient to discuss their decision with a family member or other significant person. All eligible persons, 18 years and over, could choose an assisted death without family knowing.
• There is no mandatory psychological assessment or effective screening for depression. Research shows that requests for an assisted death are commonly influenced by depression, something that is extremely difficult to detect and often mistaken for ‘appropriate sadness’.
• The NZ Medical Association and Hospice NZ, who oppose the Act, share concerns that it lacks processes enabling clinicians to be confident a person is making their request free of pressure from others.
• The two doctor ‘safeguard’ is weak; neither of the doctors need to have met the person previously.
• There is no mandatory stand-down period as there is in other countries - under the Act, a person could be dead less than 4 days after diagnosis.
• Unlike laws overseas, there is no requirement for independent observers or witnesses at any stage.
• The Act does not require a person to be assessed for competency at the time when the lethal dose is being administered, as is the case with laws overseas.

The referendum is binding, meaning the Act cannot be changed - it will be enacted in its current form. 

We are also concerned that the practice of assisted suicide and euthanasia will become normalised over time, leading to a broadening of the criteria for eligibility as seen overseas. There is also evidence showing that people choose assisted death because of a lack of palliative care options. There is a risk this will also happen in New Zealand because effective palliative care is not yet universally available to all.

We acknowledge the importance of exercising freedom of choice. At the same time there is a need to balance individual choice with the common good of society. On balance, we believe that the significant weaknesses and dangers of the Act strongly outweigh the benefits that supporters of euthanasia seek. 

Even those who favour some form of assisted death have many reasons to Vote NO to the End of Life Choice Act.

Archbishop Philip Richardson               
Primate, Senior Bishop of the New Zealand Pakeha Dioceses and Bishop of Diocese of Waikato & Taranaki

Bishop Jay Behan                                  
Church of Confessing Anglicans, Aotearoa New Zealand

Pastor Steve Burgess                            
Regional Director, C3 Churches Pacific

Commissioner Mark Campbell              
Territorial Commander, Salvation Army, New Zealand Territory

Bishop Patrick Dunn                             
President of the NZ Catholic Bishops Conference; Catholic Diocese of Auckland

Dr Mustafa Farouk QSM                       
President, The Federation of Islamic Associations of NZ (FIANZ)

Rev Tavita Joseph Filemoni                 
General Secretary, Wesleyan Samoan Methodist Church of New Zealand & Australia

Charles Hewlett                                    
National Leader of the Baptist Churches of NZ

Rev. Brett Jones                                   
National Superintendent (Acting), Wesleyan Methodist Church of NZ

Right Reverend Fakaofo Kaio              
Moderator, The Presbyterian Church in New Zealand                

Metropolitan Myron                             
New Zealand Greek Orthodox Church

Rev Dr Stuart Lange                            
National Director, New Zealand Christian Network

Pastor David MacGregor                      
National Director, Vineyard Churches Aotearoa NZ; Senior Pastor, Grace Vineyard Church Christchurch

Rev Andrew Marshall                           
National Director, Alliance Churches of New Zealand

Pastor Peter Mortlock                         
Senior Pastor, City Impact Churches of NZ

Archbishop Don Tamihere                    
Anglican Primate, Pihopa o Aotearoa and Pihopa o Te Tairawhiti

Rev Setaita Taumoepeau K. Veikune   
President, Methodist Church of New Zealand

Pastor Adam White                               
Leader, New Life Churches of New Zealand

Bishop Mark Whitfield                          
Lutheran Church of New Zealand

Bishop Ross Bay                                   
Anglican Diocese of Auckland   

Bishop Steven Benford                        
Anglican Diocese of Dunedin

Bishop Peter Carrell                             
Anglican Diocese of Christchurch

Cardinal John Dew                               
Catholic Archdiocese of Wellington

Bishop Michael Dooley                         
Catholic Diocese of Dunedin

Bishop Justin Duckworth                     
Anglican Diocese of Wellington

Pastor Max Faletutulu                          
Senior Pastor, Titahi Bay Community Church, Wellington

Bishop Michael Gielen
Catholic Diocese of Auckland - Auxiliary

Bishop Andrew Hedge                          
Anglican Diocese of Waiapu

Bishop Stephen Lowe                           
Catholic Diocese of Hamilton

Bishop Steve Maina                              
Anglican Diocese of Nelson

Pastor Kaio Mamea                              
The Light of All Nations Church, Wellington

Bishop Paul Martin SM                         
Catholic Diocese of Christchurch

Bishop Te Kitohi Pikaahu                      
Pihopatanga o Te Taitokerau

Bishop Waitohiariki Quayle                  
Pihopatanga o Te Upoko o Te Ika

Rt Revd Dr Eleanor Sanderson             
Assistant Anglican Bishop of Wellington

Bishop Richard Wallace                        
Pihopatanga o Te Waipounamu

Rev Brian Walsh                                   
Local Administrator, Catholic Diocese of Palmerston North